National Honor Society Candidate Application

National Honor Society Candidate Application

Student Information

(All fields are required)
Student ID#

Instructions

Before completing this application, you must read and understand the Selection Criteria & Requirements page included in this packet. Type directly into this form. Only typed applications will be accepted. Arrange all materials in the order according to the checklist included in your application packet. Attach all forms using a paperclip – do not staple. Applications must be submitted to room 424 before 2:30pm on Friday, September 18, 2015. Only complete applications will be considered. Please read the Candidacy Packet Checklist for detailed instructions. A complete application packet includes:
  Completed candidate application
  Two Teacher Recommendation forms (blue)
  One Community Member Recommendation form (purple)
  Two Leadership Evaluation forms in sealed and signed envelopes (yellow)
  Signed agreement to the Pine-Richland NHS Chapter Membership Requirements (green)

LEADERSHIP EXPERIENCES

A student must identify TWO (2) leadership experiences at school or in the community. Students should be specific about their duties, responsibilities and actions in each leadership role. A title or position is not necessarily required, but student must provide adequate information regarding the leadership role and responsibilities. Only those positions in which the student was directly responsible for directing or motivating others evidenced by observable and documented actions and leadership behaviors should be included.
Students must be specific about their duties, responsibilities and actions in each leadership role.
For each leadership experience listed, an explanation must be provided that clearly explains the active leadership activities performed by the candidate. Please see the NHS Selection Criteria & Requirements document for a list of examples and non-examples . The leadership activity must have occurred between the start of grade nine and the time of application.
Each leadership experience included on the application must be evidenced and verified by a Leadership Evaluation Form in a sealed envelope with a signature over the seal. The form may be scanned and emailed if the sponsor is not accessible, but must be completed and submitted with all other packet materials.

Leadership Experience 1

Leadership Role:
Activity/Organization: / Name of Supervising Adult:
Supervisor email address:
Grade Levels: / 9 10 11 / Supervisor phone #:
Describe specific actions and leadership behaviors:

Leadership Experience 2

Leadership Role:
Activity/Organization: / Name of Supervising Adult:
Supervisor email address:
Grade Levels: / 9 10 11 / Supervisor phone #:
Describe specific actions and leadership behaviors :

SERVICE

To be selected as a member, a candidate must demonstrate on his or her Candidate Form the completion of 20 hours of service performed at school or in the community since the start of ninth grade. Service is generally considered to be those actions undertaken by the student which are done with or on behalf of others not including family members without any direct benefit or compensation. Service should be on going. The committee looks for continuity and quality as well as overall hours. Paid positions, fundraising activities for school or personal trips and homecoming activities do not qualify. Please note: Helping your family and/or peers is NOT considered service. Tutoring your peers in the same class qualifies as a study group; not as tutoring or service. Please see the NHS Selection Criteria & Requirements document for additional clarification regarding service requirements.
Service activities mentioned by candidates on the application MUST include signature verification and phone number of the adult supervisor of the activity under consideration. Email correspondence, copies of certificates and other official documentation may be used in lieu of signatures that cannot be obtained.

Service Activity 1

Service Activity/ Org. / Number of Hours: / Name of Supervising Adult:
Grade Levels: / 9 10 11 / Supervisor phone #: / SupervisorSignature:
Description of Service Activities:

Service Activity 2

Service Activity/ Org. / Number of Hours: / Name of Supervising Adult:
Grade Levels: / 9 10 11 / Supervisor phone #: / SupervisorSignature:
Description of Service Activities:

Service Activity 3

Service Activity/ Org. / Number of Hours: / Name of Supervising Adult:
Grade Levels: / 9 10 11 / Supervisor phone #: / SupervisorSignature:
Description of Service Activities:

Service Activity 4

Service Activity/ Org. / Number of Hours: / Name of Supervising Adult:
Grade Levels: / 9 10 11 / Supervisor phone #: / SupervisorSignature:
Description of Service Activities:

Work Experience

Position: / Employer: / Dates:
Job Description/Responsibilities:
Position: / Employer: / Dates:
Job Description/Responsibilities:
Position: / Employer: / Dates:
Job Description/Responsibilities:

Extracurricular activities

Describe your involvement in the organization. Activities listed without a description of the individual student’s roles or participation will not be considered in the evaluation process. Include any information that you feel will help the council understand that you are an active, involved member; not simply signed up with a club or organization. How did you contribute?
Activity: / Grade Levels: / 9 10 11
Description of Involvement/Participation:
Activity: / Grade Levels: / 9 10 11
Description of Involvement/Participation:
Activity: / Grade Levels: / 9 10 11
Description of Involvement/Participation:
Activity: / Grade Levels: / 9 10 11
Description of Involvement/Participation:

recognition and awards

List any significant awards and/or recognition that you have received since the beginning of grade nine. Only include awards that further demonstrate how you embody the four pillars of National Honor Society – scholarship, leadership, service and/or character.
Recogntion/Award: / Grade Levels: / 9 10 11
Recogntion/Award: / Grade Levels: / 9 10 11
Recogntion/Award: / Grade Levels: / 9 10 11
Recogntion/Award: / Grade Levels: / 9 10 11
Recogntion/Award: / Grade Levels: / 9 10 11

ESSAY

The essay must be 500 words or less and must communicate succinctly and effectively why and how you represent the four pillars of the National Honor Society: Character, Leadership, Service, and Scholarship.

Acknowledgement of NHS Commitment

Please read and sign the “The National Honor Society Pine-Richland Chapter Membership Requirements And Acknowledgement of NHS Commitment” (2-sided green paper). The signed paper must be submitted separately. See the checklist for specific instructions.